Gradient In Self-rated Health Research Articles

Is the mediating effect of psychosocial stress on the income–health relationship moderated by income inequality?

BackgroundThere now exists a rich body of literature on the relationship between income, income inequality, and health. The discussion about the impact of income and income inequality on health includes psychosocial mechanisms, such as long-term perceptions of inferiority and social positioning, material advantage from income, and the structural conditions that define what people can do with their material resources. AimsThis study investigated the extent to which income's effects on health are mediated by psychosocial stress, and to what extent those effects are moderated by country-level income inequality and economic development. MethodsData were collected from The European Social Survey, round 7. Multilevel moderated mediation analysis was applied to estimate the extent of psychosocial stress mediation of the effects of income on self-rated health. Moderated parameters were estimated over country-level income inequality and economic development. ResultsSignificant full or partial meditation by psychosocial stress was found in all 20 countries studied. Effects moderated by income inequality and GDP per capita showed expected relationships but failed to reach conventional levels of statistical significance. ConclusionsIndividual-level income remains important for explaining the income–health gradient in self-rated health in Europe. The income–health relationship and the extent to which it is mediated by psychosocial stress varies among countries but is not significantly moderated by contextual income or income inequality. Policies should be aimed at allowing a greater proportion of people to live in material comfort and reduced sense of financial precarity, and protecting individuals from harmful consequences of low income.

Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys.

This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries. We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level. There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications. These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

Physical and psychosocial work factors as explanations for social inequalities in self-rated health.

We investigated the contribution of physical and psychosocial work factors to social inequalities in self-rated health (SRH) in a sample of Danish 40 and 50 years old occupationally active women and men. In this longitudinal study, the study population consisted of 3338 Danish women and men. Data were collected by postal questionnaires in 2000 (baseline) and 2006 (follow-up). The independent variable, socioeconomic position (SEP), was assessed by the highest achieved educational level at baseline. We conducted gender-stratified parallel multiple mediation analyses. In the mediation analyses, SEP was categorised as SEP I, II, III, VI and V among men. Among women, SEP was dichotomised into SEP I-IV and V. The outcome, SRH, was assessed at baseline and follow-up. A wide range of physical and psychosocial work factors were included as potential mediators. We found a social gradient in SRH across all levels of SEP among men. Among women, we only found a poorer SRH among those with the lowest SEP. Mediation analyses showed that work factors together accounted for 56% of the social inequalities in SRH among men and 44% among women. In both genders, ergonomic exposures and job insecurity seemed to play the major role for social inequalities in SRH. For women only, we also found noise to contribute to the social inequalities in SRH. Physical and psychosocial work factors partially explained social inequalities in SRH among both genders. Improvement of the working environment can potentially contribute to the reduction of social inequalities in health.

Gender disparities in the education gradient in self-reported health across birth cohorts in China

BackgroundVariation in the relationship between education and health has been studied intensely over the past few decades. Although there is research on gender disparity and cohort variations in educational effect on health using samples from the U.S. and Europe, research about China’s is limited. Given the specific social changes in China, our study is designed to analyze the gender and cohort patterns in the education-health gradient.MethodThe latent growth-curve modeling was used to analyze the gender and cohort variations in the education gradient in self-rated health among Chinese respondents. The study employed longitudinal and nationally representative data from the Chinese Family Panel Studies from the years 2010 to 2016. Each cohort is specified according to their distinct periods of social change in China. Following the analysis, we used latent growth-curve model to illustrate gender and cohort differences in the age-graded education and health trajectories.ResultsAlthough Chinese men have reported to have better health than women in general, women reported 1.6 percentage points higher in self-reported health for each additional year of schooling compared to that of men (P < 0.001). The latent growth curve model showed women’s extra education benefits were persistent overtime. Compared to the people born during the “Old China” (1908–1938), the education gradient in self-rated health did not change for cohorts born before 1955 and after 1977, but the education-health gap changed significantly in the 1956–1960 (O.R. = 1.038, P < 0.05), 1967–1976 (O.R. = 1.058, P < 0.001), and 1977–1983 (O.R. = 1.063, P < 0.001) cohorts. There was a gender difference for the cohort variations in the education-health gradient. For women, the education effect in the 1956–1960 (O.R. = 1.063, P < 0.05), 1967–1976 (O.R. = 1.088, P < 0.001) and 1977–1983 (O.R. = 1.102, P < 0.001) cohorts was significantly higher than that of the 1908–1938 cohort. On the contrary, the education-health gradient remained the same across all cohorts for men.ConclusionOur study suggests that the education-health gradient varies across cohorts for women, but the size of education effect remains consistent for men across cohorts. The findings support the resource-substitution hypothesis and not the rising-importance hypothesis in China. We discussed the potential influences of the unique, social transformation and educational expansion in China.

Ageing, health inequalities and the welfare state: A multilevel analysis

Comparative studies of health inequalities have largely neglected age and ageing aspects, while ageing research has often paid little attention to questions of social inequalities. This article investigates cross-country differences in gradients in self-rated health and limiting long-standing illness (LLSI) in middle-aged and in older people (aged 50–64 and 65–80 years) linked to social class, and degrees to which the social health gradients are associated with minimum pension levels and expenditure on elderly care. For these purposes, data from the European Social Survey (2002–2010) are analysed using multilevel regression techniques. We find significant cross-level interaction effects between class and welfare policies: higher expenditure on elderly care and particularly more generous minimum pensions are associated with smaller health inequalities in the older age group (65–80 years). It is concluded that welfare policies moderate the association between social class and health, highlighting the importance of welfare state efforts for older persons, who are strongly reliant on the welfare state and welfare state arrangements such as pensions and care policies.

Social capital, income inequality and the social gradient in self-rated health in Latin America: A fixed effects analysis

Latin America is the most unequal region in the world. The current sustainable development agenda increased attention to health inequity and its determinants in the region. Our aim is to investigate the social gradient in health in Latin America and assess the effects of social capital and income inequality on it. We used cross-sectional data from the World Values Survey and the World Bank. Our sample included 10,426 respondents in eight Latin American countries. Self-rated health was used as the outcome. Education level was the socioeconomic position indicator. We measured social capital by associational membership, civic participation, generalized trust, and neighborhood trust indicators at both individual and country levels. Income inequality was operationalized using the Gini index at country-level. We employed fixed effects logistic regressions and cross-level interactions to assess the impact of social capital and income inequality on the heath gradient, controlling for country heterogeneity. Education level was independently associated with self-rated health, representing a clear social gradient in health, favoring individuals in higher socioeconomic positions. Generalized and neighborhood trust at country-level moderated the effect on the association between socioeconomic position and health, yet favoring individuals in lower socioeconomic positions, especially in lower inequality countries, despite their lower individual social capital. Our findings suggest that collective rather than individual social capital can impact the social gradient in health in Latin America, explaining health inequalities.

Social inequalities in self-rated health in Ukraine in 2007: the role of psychosocial, material and behavioural factors

Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health. Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors. In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women. The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty.

The educational gradient in self-rated health in Europe

Research suggests that doctor–patient relations have evolved from a doctor-centered, paternalistic approach towards a more patient-centered, egalitarian model of interactions between physicians and their patients. Given the long-running debate on the positive relationship between education and health, the question arises how this development in doctor–patient relations affects social inequalities in health. First, we test to what extent egalitarian (e.g. discussing treatment decisions with patients) doctor–patient relations are underlying the education–self-reported health association. Second, we test whether egalitarian and paternalistic (e.g. withholding some information from patients) doctor–patient relations show differential effects on self-reported health across educational groups. Analyses of the European Social Survey (ESS) 2004/2005 for 24 countries demonstrate that a more egalitarian doctor–patient relationship does not substantially reduce educational inequalities in self-reported health. However, some direct positive effects of egalitarian and direct negative effects of paternalistic doctor–patient relations on health ratings can be found. Finally, results show how the health status of the lower educated can improve with a more egalitarian and less paternalistic doctor–patient relationship.

Educational gradients in five Asian immigrant populations: Do country of origin, duration and generational status moderate the education-health relationship?

Education usually shows a relationship with self-rated health such that those with highest education have the best health and those with lowest education have the worst health. We examine these educational gradients among Asian immigrants and whether they differ by country of origin, duration in the United States, and generational status. Migration theories suggest that recent immigrants from poorer countries should show a weaker relationship between education and health than US-born Whites. Acculturation theory further suggests that differences in gradients across country of origin should diminish for longer-term immigrants and the US-born and that these groups should display gradients similar to US-born Whites.We use the March Current Population Survey (2000 − 2010) to examine educational gradients in self-rated health among recent immigrants (≤ 15 years duration), longer-term immigrants (> 15 years duration), and second generation US-born Asians from China (n = 4473), India (n = 4,307), the Philippines (n = 5746), South Korea (n = 2760), and Japan (n = 1265).We find weak or non-significant educational gradients among recent Asian immigrants across the five countries of origin. There is no indication that longer-term immigrants display significant differences across educational status. Only second generation Chinese and Filipinos show significant differences by educational status.Overall, Asians show an attenuated relationship between education and self-rated health compared to US-Whites that persists over duration in the US and generational status. Our findings show shortcomings in migration and acculturation theories to explain these gradient patterns. Future research could use binational data or explore psychosocial factors to identify potential suppressors of educational gradients.

Socioeconomic Inequalities in Health in China: A Reassessment with Data from the 2010-2012 China Family Panel Studies.

Despite well documented high levels of socioeconomic inequalities, health gradients by socioeconomic status (SES) in contemporary China have been reported to be limited. Using data from the 2010–2012 China Family Panel Studies, we reexamine associations between three sets of SES—human capital, material conditions, and political capital—and self-rated health among Chinese adults 18–70 years old, capitalizing on anchoring vignette data to adjust for reporting heterogeneity. We find strong evidence of substantial variations in reporting behaviors by education, cognition, and family wealth but not by family income or political capital. Failing to correct for reporting heterogeneity can bias the estimates of SES gradients in self-rated health as much as nearly 40 %. After vignette adjustment, we find significantly positive associations of education, family income, wealth, and political capital with self-rated health. Individuals’ cognitive capacity, however, does not predict self-rated health.

Economic Development and Socioeconomic Inequality of Well-Being: A Cross-Sectional Time-Series Analysis of Urban China, 2003–2011

This study examines how economic development influences the effects of socio-economic status (SES, measured with education and income) on individuals’ well-being (happiness, self-rated health, and depression) in urban China. Building on Tversky and Griffin’s judgment model of well-being, we propose an endowment and a contrast hypothesis for the variation of SES gradients in well-being across economic contexts. Drawing on six waves of the Chinese General Social Survey (CGSS 2003, 2005, 2006, 2008, 2010, 2011) and allowing for non-linear development effects, we obtain four main findings: (1) the widely observed SES gradients in physical health are confirmed not only for self-rated health (SRH) but also for happiness and depression among urban residents in China. However, the SES gradients are contingent on economic development in two systematic ways; (2) consistent with both theoretical hypotheses, SES gradients in happiness are positive at lower levels of economic development but become negligible and insignificant at the highest level; (3) consistent with the contrast hypothesis, SES gradients in SRH and depression are substantially smaller at the highest level of economic development. Inconsistent with the endowment hypothesis, these SES gradients are also smaller at the lowest level, suggesting that an impoverished environment can significantly limit the endowment effects of SES; and (4) given the broad support for the contrast hypothesis, we further consider its generating mechanism. A preliminary test does not support the role of relative status, as emphasized by Tversky and Griffin. We therefore discuss two alternative theoretical mechanisms.

The contribution of lifestyle and work factors to social inequalities in self-rated health among the employed population in Switzerland

We sought to examine the joint and independent contributions of working conditions and health-related behaviours in explaining social gradients in self-rated health (SRH). Nationally representative cross-sectional data from the Swiss Health Survey of 2007 were used for this study. Bi- and multivariate statistical analyses were carried out on a sample of 6950 adult employees of working age. We examined a comprehensive set of five health behaviours and lifestyle factors as well as twelve physical and psychosocial work factors as potential mediators of the relationship between social status and SRH. Analyses were stratified by sex and performed using two measures of social status, educational level and occupational position. Strong social gradients were found for SRH, but mainly in men whereas in women the associations were either not linear (educational level) or not statistically significant (occupational position). Social gradients were also found for most lifestyle and all physical and psychosocial work factors studied. These three groups of factors equally contributed to and largely accounted for the social gradients in SRH although not all of the individual factors turned out to be independent and significant risk factors for poor SRH. Such risk factors included physical inactivity and obesity, poor posture and no or low social support at work (both sexes), heavy smoking (men) and underweight, overweight, uniform arm or hand movements at work, monotonous work and job insecurity (women). In conclusion, social inequalities (or more precisely educational and occupational status differences) in SRH were more pronounced in men and can be attributed for the most part to a sedentary lifestyle and to a physically demanding and socially unsupportive and insecure work environment. Apart from this main finding and overall pattern, sex-specific risk profiles were observed with regard to SRH and need to be taken into consideration.

The color of health: Skin color, ethnoracial classification, and discrimination in the health of Latin Americans

Latin America is one of the most ethnoracially heterogeneous regions of the world. Despite this, health disparities research in Latin America tends to focus on gender, class and regional health differences while downplaying ethnoracial differences. Few scholars have conducted studies of ethnoracial identification and health disparities in Latin America. Research that examines multiple measures of ethnoracial identification is rarer still. Official data on race/ethnicity in Latin America are based on self-identification which can differ from interviewer-ascribed or phenotypic classification based on skin color. We use data from Brazil, Colombia, Mexico, and Peru to examine associations of interviewer-ascribed skin color, interviewer-ascribed race/ethnicity, and self-reported race/ethnicity with self-rated health among Latin American adults (ages 18–65). We also examine associations of observer-ascribed skin color with three additional correlates of health – skin color discrimination, class discrimination, and socio-economic status. We find a significant gradient in self-rated health by skin color. Those with darker skin colors report poorer health. Darker skin color influences self-rated health primarily by increasing exposure to class discrimination and low socio-economic status.

Does Healthcare Moderate the Impact of Socioeconomic Status on Selfrated Health?

Background: Empirical evidence is growing for the fact that societal conditions are major causes of differences in health across individuals and societies. A positive correlation between socioeconomic status and health outcomes is documented in countries with various welfare arrangements, level of social trust, and health policies. We investigated how the health gradient was affected by healthcare intervention. Methods: Self-reported data on health status after exposure to healthcare intervention was collected by means of a postal survey (2009) to all members of the Norwegian Breast Cancer Association. Response rate was 62 percent. 1666 women aged 40-69 was included in the analysis. In order to create a counterfactual framework, we used propensity score analysis to match each observation in the treatment sample with an observation in a non-treatment sample. The observations were classified into high and low socioeconomic status groups based on information on education and labor market affiliation. Results and conclusion: A social gradient in self-rated health was found. Experience of breast cancer and treatment was shown to have a moderating effect on the gradient. While high-status women on average reported a 0.63 points reduction in health after breast cancer treatment, the corresponding reduction for low status women was 0.32 points. These results lend some support to the hypothesis that individuals from lower status groups may benefit from healthcare more than others due to effects of information and support.

Social factors iand self-rated health in Almaty, Kazakhstan: results from a cross-sectional community-based survey

A Abikulova, K Tulebaev, A Izekenova, A Kumar, M Ramazanova, AG Ryskulova, B Zhanturyiev, Z Sagyndykova, A Raushanova, G Aimbetova, E Abdraimova, A Grjibovski School of Public Health, Kazakh National Medical University, Almaty, Kazakhstan Kazakh Russian Medical University, Almaty, Kazakhstan Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway International School of Public Health, Northern State Medical University, Arkhangelsk, Russia Contact: andrej.grjibovski@gmail.com Background Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. However, no studies have been performed in Central Asia. The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan. Methods Altogether, 1500 randomly selected adults aged 45 years or older were invited to participate in a cross-sectional study and 1199 agreed (response rate 80%). SRH was classified as poor, satisfactory, good and excellent. Multinomial logistic regression was applied to study associations between SRH and sociodemographic characteristics. Crude and adjusted odds ratios (OR) for poor vs. good and for satisfactory vs. good health were calculated with 95% confidence intervals (CI). Results Altogether, poor, satisfactory, good and excellent health was reported by 11.8%, 53.7%, 31.0% and 3.2% of the responders, respectively. Clear gradients in SRH were observed by age, education and income in both crude and adjusted analyses. Women were more likely to report poor (OR = 1.9, 95% CI: 1.2-3.1) or satisfactory (OR = 1.6, 95% CI: 1.2-2.1) than good health. Ethnic Russians and unmarried participants had greater odds for poor vs. good health (OR = 2.3, 95% CI: 1.5-3.7 and OR = 4.0, 95% CI: 2.7-6.1, respectively) and for satisfactory vs. good health (OR = 1.4, 95% CI: 1.1-1.9 and OR = 1.9, 95% CI: 1.4-2.5, respectively) in crude analysis, but the estimates were reduced to non-significant levels after adjustment. Unemployed and pensioners were less likely to report good health than white-collar workers while no difference in SRH was observed between whiteand blue-collar workers. Conclusions Considerable levels of inequalities in SRH by age, gender, education and particularly income, but not by ethnicity or marital status were found in Almaty, Kazakhstan. Further research is warranted to identify the factors behind the observed associations in Kazakhstan. Key message Considerable levels of inequalities in SRH by age, gender, education and particularly income, but not by ethnicity or marital status were found in Almaty, Kazakhstan.

Socioeconomic Disparities and Health: Impacts and Pathways

Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997–98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society.

Socioeconomic gradients in self-rated health: a developing country case study of Enugu State, Nigeria

The use of self-rated health (SRH) as an indicator of health has generally been limited to the study of socioeconomic inequalities in industrialized societies. We evaluate the potential usefulness of this indicator in a developing country context using a data set generated from Enugu State, Nigeria, which includes information on SRH and health status index (HSI). We also evaluate the difference in the estimated socioeconomic inequality in health using two specifications of the concentration index: the standard specification and Erreygers (J Health Econ, 28:504–515, 2009a) specification. The results show that self rated health is a potentially useful indicator of health state for populations in developing countries. Our tentative results indicates that the Erreygers (J Health Econ 28:521–524, 2009b) specification of the concentration index detects larger levels of inequality than the standard specification, and thus raises questions for researchers who use results obtained from the instrument for policy advice. The simulation results also show that the level of social aversion to socio-economic differences among people would generally increase the perceived level of health inequality in a population.

The effect of immigrant generation and duration on self-rated health among US adults 2003-2007.

Global self-rated health (SRH) is increasingly a key indicator in the assessment of immigrant health. However, evidence of the impact on SRH of generational status, duration of residence in the US, and socioeconomic status (SES) among immigrants and their offspring is limited and inconsistent. We overcome limitations in existing research on this topic by using a uniquely large and diverse data source, the March Annual Social and Economic Supplement of the Current Population Survey (CPS; 2003-2007) (n = 637,209). As a result, we are able to disaggregate results by race/ethnicity, account for country of origin, and consider the role of multiple dimensions of SES. We find that overall first-generation immigrants in the US have lower odds of poor/fair SRH compared to the third-generation. This association is particularly strong for blacks and Hispanics but not significant for Asians. Among first-generation Asians and Hispanics, longer duration of residence is positively associated with poor/fair SRH. Finally, socioeconomic gradients in SRH tend to be less pronounced among the first-generation (versus the third) and, within the first-generation, among recent arrivals (versus those with longer durations). Our results highlight the importance of explicitly accounting for multiple immigration-related variables and their interactions with race/ethnicity and SES. Otherwise, studies may misestimate SRH differences by race/ethnicity and socioeconomic status. The continued growth of the US immigrant population and the second-generation underscore the need to examine patterns in immigrant health systematically.

Income, education, and class gradients in health in global perspective

It is well known that socioeconomic status (SES) is highly correlated with health. An important question is whether SES is, in this regard, a single, unified concept or a collection of related but distinct statuses. This study disaggregates SES into constituent components of income, education, and occupational class to investigate whether or not these correlate with health independently of each other. A series of multilevel regression models are estimated to predict self-rated health (SRH) as reported by 15,022 individuals in 44 countries participating in the World Values Survey. It turns out that it is possible to distinguish independent income, education, and class gradients in SRH. Two interpretations of this result are possible: each component of SES may affect health independently of the others, or each may simply capture additional information about SES that is not captured by the others. Either way, all three components of SES are clearly closely connected with SRH.

Self-rated health does not explain the socioeconomic differential in mortality: a prospective study in the EPIC-Norfolk cohort

Background:Self-rated health (SRH), a subjective measure of health, is strongly predictive of mortality, independently of objective measures of health status and existing known disease. There is a strong social gradient...